Customer Service Associate

Job Summary

A Customer Service Agent following established company guidelines resolves customer issues received by telephone, mail or fax from group administrators, subscribers and dentists.  An Agent explains Delta Dental 's group contracts, agreements, processing policies and procedures.  An Agent can also adjudicate dental claims and resolve adjustments. 

 Essential Functions & Responsibilities 

•  Adhering to the Agent's schedule, the Agent is required to be available on the call center ACD to answer customer calls while meeting and exceeding department KPI's.
• As a team member, researches and resolves inquiries and responds to customers with an appropriate and accurate written or verbal notification.
• Calculates adjustments and creates and processes claims for adjusted payments.
• Creates and processes standard claims, claims with coordination of benefits, pre-treatment estimates, and pretreatment estimates with dated services.
• Maintains and updates subscriber files with information obtained through inquiries and submitted claims and documents, i.e., individual and family on hold codes, applied or removed.
• Performs all tasks necessary to resolve all questions based on Delta Dental's claims processing guidelines and Dentist handbook, as well as Delta Dental's website and mobile application.
• Documents each inbound call in call tracking, follow up, or any pended requests.
• Generates check research requests for outstanding payments.
• Understands all claim guidelines and effectively uses this information to resolve related inquiries.
• Researches and resolves requests from other departments such as Marketing and Enrollment.
• When necessary, refers claims or subscriber eligibility to Management or other departments such as Professional Services, Claims, Marketing and Enrollment.
• Supports and participates as needed for inventory reduction tasks such as correspondence and/or call tracking.
• Other duties as assigned  

Essential Qualifications 

 Competencies 

 Knowledge, Skills & Abilities 

 KPI's 

• Adherence standard is 96% 

• After call work time – 10 seconds 

• Quality:  99% 

 Technical and Functional  

• Ability to regard customer service excellence as a priority 

• Personal computer skills with knowledge of MS applications such as Windows, Word and Excel and browser based applications such as Internet Explorer 

• Excellent communication and listening skills 

• Excellent math aptitude 

• Creativity and flexibility when solving problems 

• Ability to work in an environment where work is carefully monitored for accuracy 

 Required Physical Abilities 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

 Ability to sit and perform extensive close keyboard and PC work including data entry  

• Ability to walk, talk or hear 

• Occasionally required to stand and reach with hands and arms 

 Working Environment 

• Ability to meet attendance standards.  

• Must be able to sit/stand, talk and hear. 

• The noise level in the work environment is usually moderate. 

• This classification will be required to sign a confidentiality agreement. 

 Experience, Education and Certifications Required  

 Experience Required 

 1-3 years customer service/call center experience 

• Dental Assistant education/experience is a plus 

 Required Educational Level  

•  Requires high school diploma or equivalent. 

Other Certification 

• n/a